Ticagrelor Versus Clopidogrel for CMD in Patients With AMI: A Retrospective Study Based on the Angio-IMR

Zhejiang University

Status: Completed

Conditions: Coronary Heart Disease

Treatments: Drug: Dual antiplatelet therapy with aspirin and either ticagrelor or clopidogrel

Study type: Observational

Funder types: Other

Identifiers

NCT05978726

2023007

Details and patient eligibility

About

Coronary microvascular dysfunction (CMD) is increasingly recognized as an important indicator for long-term prognosis in patients with acute myocardial infarction (AMI). The angiography-derived index of microcirculatory resistance (angio-IMR) is a novel guidewire-free measure for CMD in patients with AMI. Ticagrelor has recently been suggested to have additional benefits on coronary microcirculation beyond its antiplatelet effect. This study was designed to compare the protective effects of ticagrelor and clopidogrel on CMD and prognostic impact in patients with AMI, using the angio-IMR as a novel assessment tool.

Enrollment: 325 patients

Sex: All

Ages: 18 to 85 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients who were diagnosed with AMI, including STEMI and NSTEMI, and underwent successful PCI and routine follow-up coronary angiography at the Second Affiliated Hospital of Zhejiang University School of Medicine between June 1, 2017 and May 31, 2020.

Exclusion criteria

• 1. prior treatment with any P2Y12 inhibitor;
• 2. need for long-term oral anticoagulation therapy;
• 3. previous coronary artery bypass grafting (CABG);
• 4. chronic renal dysfunction with estimated glomerular filtration rate (eGFR) <30 mL/ (min·1.73 m2) or on hemodialysis;
• 5. liver cirrhosis ≥Child-Pugh B class;
• 6. cancer;
• 7. adjustment of dual antiplatelet therapy (DAPT) during follow-up;
• 8. inadequate coronary angiographic images.

Trial design

325 participants in 2 patient groups

ticagrelor maintenance treatment group

Description:

Patients received dual antiplatelet therapy (DAPT) with aspirin 100mg daily and ticagrelor 90mg twice daily for at least 9 months after PCI. Angio-IMR assessment was performed after primary PCI and during routine follow-up coronary angiography.

Treatment:

Drug: Dual antiplatelet therapy with aspirin and either ticagrelor or clopidogrel

clopidogrel maintenance treatment group

Description:

Patients received dual antiplatelet therapy (DAPT) with aspirin 100mg daily and clopidogrel 75mg once daily for at least 9 months after PCI. Angio-IMR assessment was performed after primary PCI and during routine follow-up coronary angiography.